Individual
DR. JACQUELYN L WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5615 HOOD ST, COLUMBIA, SC 29207-5109
(803) 751-3255
Mailing address
600 GREENLAWN DR APT 5310, COLUMBIA, SC 29209-0527
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012794A
IN
Other
Enumeration date
08/02/2017
Last updated
08/02/2017
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